The Outcome of Sudan National AIDS Spending
By Ommniyah Elfatih Yousif,
National AIDS Spending Assessment (NASA) is standardized tool provides indicators of the country financial response to HIV and AIDS and to support the monitoring of resource mobilization. It’s conducted in Sudan as a joint work between Health Economics Department, Federal Ministry of Health, the Sudanese National AIDS Control Program (SNAP) and UNAIDS.
Data collection form, adapted from UNAIDS, was distributed to different entities to report their HIV and AIDS expenditures for the calendar years 2008 and 2009. Hard copies of data received were compiled, and systematically filed. Data Processing Form was used to counter-check data for completeness, accuracy, double count, and appropriate category classification. Finally data were entered into the NASA resource tracking software to develop different matrices.
75% of Twenty-eight targeted organizations with NASA data collection efforts were multilateral agencies or local NGOs. Only seven government entities participated in the NASA assessment based on their involvement either as agent or provider of services.
In 2008, of the total spending of US$15,358,623 for HIV and AIDS, 71.5% was financed by Global Fund. Government financing was 13.5%. Other Multilateral donors such as UNAIDS, UNFPA, UNICEF were responsible for the rest. In 2009 of the total spending of US$16,708,579 for HIV and AIDS, 73.2% came from the Global Fund and the government financing was 9.5%.
Financing agents are entities which mobilize financial resources collected from different financing sources or pools and transfer them to pay for or to purchase health care or other goods and services. UN organizations as agents spent 75.7% of total spending in 2008 while the government entities spent almost 22%. In 2009 UN organizations spent 75.7% of total spending of which 63.36% paid by UNDP. The government entities spent almost 22%.
Most of the agents were acting as providers of HIV/AIDS services themselves. UN agencies were the major providers of HIV/AIDS services in both 2008 and 2009 (68.49% and 78.89%). Almost, 50% of fund available for HIV services in the country was used by UNDP as a provider of HIV/AIDS control activities. SNAP, classified as government entity provided 27.58% of the HIV services. In 2009 SNAP provided 17.7% of the HIV services.
In 2008, of total expenditure the major amount (59%) was spent on programme management and administration, comprising expenditures on monitoring and evaluation, operational research, drug supply system, upgrading infrastructure, and others. This is almost 12 times more than the allocated budget in the NSP (4.8%). Spent on prevention categories was only 10% of the total expenditure. Enabling environment categories spent 3.8%. Orphans and vulnerable children, social protection and social services, care and treatment and research registered the lowest expenditure (less than 1% each). Almost a quarter of the fund (26%) was spent on human resources.
In 2009, 59% of HIV/AIDS spending was on programme management and administration. The spent on prevention categories reach almost 16%, enabling environment recorded was 3.5%. Orphans and vulnerable children, social protection and social services and research were less than 1% each. Care and treatment was almost 7%. Human resources expenditure, which includes expenditure on monetary incentives for human resources, formative education to build-up an HIV workforce, training and others, reduced and became less than 15%.
The major spending in 2008 (45%) was targeting most at risk population. 21.5% of the expenditure spent on non targeted interventions. General population targeted with 7.4% of the expenditure while specific accessible populations receive 21% of the funds. In 2009 the spending on non targeted interventions almost doubled (46%) and expenditure on most at risk populations decreased sharply to less than 2%. People living with HIV received 17.6% of the funds allocated for HIV services. Expenditure on other key populations showed increase in spending and reach 7.4% and spending on specific accessible populations was 24%. General population was targeted with only 2.4% of the HIV services.
NASA 2008 and 2009 data showed weak involvement and engagement of other government sectors rather than Ministries of Health in the efforts to control the disease both in funding and providing HIV/AIDS services. Also, NASA had clarified the weak financial reporting of some national NGOs. UNDP and other UN agencies should consider supporting the development of a sustainable capacity building programme on financial management especial for those NGOs receiving support from Global Fund.